Intraoperative hyperglycemia is independently associated with infectious complications after non-cardiac surgery

Abstract

BackgroundPerioperative hyperglycemia and its associated increase in morbidity and mortality have been well studied in the critical care and cardiac surgery literature. However, there is little data regarding the impact of intraoperative hyperglycemia on post-operative infectious complications in non-cardiac surgery.MethodsAll National Surgery Quality Improvement Program patients undergoing general, vascular, and urological surgery at our tertiary care center were reviewed. After integrating intraoperative glucose measurements from our intraoperative electronic health record, we categorized patients as experiencing mild (8.3–11.0 mmol/L), moderate (11.1–16.6 mmol/L), and severe (≥ 16.7 mmol/L) intraoperative hyperglycemia. Using multiple logistic regression to adjust for patient comorbidities and surgical factors, we evaluated the association of hyperglycemia with the primary outcome of postoperative surgical site infection, pneumonia, urinary tract infection, or sepsis within 30 days.ResultsOf 13,954 patients reviewed, 3150 patients met inclusion criteria and had an intraoperative glucose measurement. 49% (n = 1531) of patients experienced hyperglycemia and 15% (n = 482) patients experienced an infectious complication. Patients with mild (adjusted odds ratio 1.30, 95% confidence interval [1.01 to 1.68], p-value = 0.04) and moderate hyperglycemia (adjusted odds ratio 1.57, 95% confidence interval [1.08–2.28], p-value = 0.02) had a statistically significant risk-adjusted increase in infectious complications. The model c-statistic was 0.72 [95% confidence interval 0.69–0.74].ConclusionsThis is one of the first studies to demonstrate an independent relationship between intraoperative hyperglycemia and postoperative infectious complications. Future studies are needed to evaluate a causal relationship and impact of treatment.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0546-0) contains supplementary material, which is available to authorized users.

Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database

“…In this previous study, the physician authors recommend closely examining the patients with risk factors that were individually significant such as smoking, cardiac dysrhythmias, or sleep apnea, or factors that were near significance and assess them in the context with overall comorbidities and other patient characteristics to determine if additional infection prevention may be appropriate for that patient. Previous literature has identified diabetes, obstructive sleep apnea, and a history of chronic obstructive pulmonary disease as risk factors for surgical site infections . Although not reaching statistical significance, both the prevalence of diabetes mellitus and peripheral vascular disease were higher in the individuals that had an infection in the reimplantation group.…”

Improvement in Hyperglycemia Prevents Surgical Site Infection Irrespective of Insulin Therapy in Non‐diabetic Patients Undergoing Gastrointestinal Surgery

“…These pathophysiologic changes also cause cellular damage and vascular dysfunction. Substantial evidence indicates that correction of hyperglycemia with insulin therapy reduces complications, including SSI, in patients undergoing cardiac and general surgery [1][2][3][4][5]. To determine the ability of BG control to prevent SSI, SSI rates in patients whose hyperglycemia improved were compared with those of patients with persistent hyperglycemia.…”

Peroperative Period with Diabetes Mellitus

“…Glukoz ölçümü ve yönetimi non-kardiyak cerrahi geçiren DM hastalarından, major cerrahi geçiren DM hastası olmayanlara kadar tüm hastalarda değerlendirilmelidir (47) . Perioperatif insülin tedavisi alan hastalarda 1-2 saat aralıklarla kan şekeri, 4 saat aralıklarla serum potasyum seviyelerinin kontrol edilmesi önerilmekte, bu aralıklar cerrahi süreye, hastaya ve kullanılan insülinin tipine bağlı değişebilmektedir (15,48) .…”

“…Yapılan çalışmalarda, hiperglisemi ile yüzeyel yara yeri enfeksiyonları, ciddi enfeksiyonlar, hastanede kalış süresi ve geri kabul arasında doz yanıt ilişkisi de belirlenmiştir (59) . HbA1c düzeylerinin > %7 olmasının torasik ve lomber spinal enstrümantasyon cerrahisi için daha yüksek cerrahi alan enfeksiyon oranları ile ilişkili olduğu bulunmuştur (47) . Vasküler cerrahi geçiren hastalarda yapılan bir çalışmada ise, hiperglisemi ile 11 farklı negatif sonuç arasında (postoperatif miyokard enfarktüsü, akut böbrek yetmezliği, inme, yara komplikasyonları ve ameliyat odasına geri dönüş, 30 günlük mortalite vb.)…”